ABLE 4 - Med Cards 2

Doxepin

Brand: Sinequan, Silenor

Class: tricyclic antidepressant

Common Dosing by Indication:

depression, anxiety, alcoholism - 25-50mg PO daily (or 75mg PO daily if mild/moderate) up to 300mg/day

insomnia - 6mg PO daily HS (3mg if 65y/o or older)

MOA: prevents reuptake of NE, inhibits histamine receptors to produce sleep related side effects

ADE (>10%): xerostomia

Monitoring Parameters:

efficacy - improvement in symptoms

safety - worsening depression, suicidality, changes in behavior, EKG, LFTs, BP, electrolytes, BMI, weight

Duloxetine

Brand: Cymbalta

Class: SNRI

Common Dosing by Indication:

anxiety, diabetic peripheral neuropathy - 60mg PO daily up to 120mg/day

depression - 20-30mg PO BID OR 60mg PO daily up to 120mg/day

fibromyalgia - 30mg PO daily up to 60mg/day

MOA: inhibits reuptake of serotonin and NE, increasing their activity in the CNS

ADE (>10%): abdominal discomfort, drowsiness, headache, nausea, xerostomia

Monitoring Parameters:

efficacy - improvement in symptoms

safety - worsening of depression, suicidality, changes in behavior, BP, CBC, electrolytes, renal function, LFTs, ocular pressure, mydriasis, glucose control in diabetics

Eletriptan

Brand: Relpax

Class: antimigraine, serotonin, receptor, agonist

Common Dosing by Indication:

migraine - 20-40mg PO at onset of migraine, may repeat dose after 2 hours prn, max 40mg/dose and 80mg/day

MOA: binds to serotonin receptors 1B, 1D, and 1F, produces either vasoconstriction or activation of nerves in trigeminal system, results in inhibition of proinflammatory cascade

ADE (>10%): weakness

Monitoring Parameters:

efficacy - resolution of migraine

safety - ischemic bowel disease, peripheral vascular disease, serotonin syndrome, ischemic cardiac syndrome, hypertensive crisis

Escitalopram

Brand: Lexapro

Class: SSRI

Common Dosing by Indication:

depression - 10mg PO daily up to 20mg/day

anxiety - 5-10mg PO daily up to 20mg/day

MOA: S-enantiomer of citalopram, selectively inhibits reuptake of serotonin

ADE (>10%): diarrhea, headache, impotence, insomnia, nausea, sedation

Monitoring Parameters:

efficacy - improvement in symptoms

safety - worsening of depression, suicidality, changes in behavior, abnormal bleeding, LFTs, SCr, CBC, electrolytes, EKG

Estradiol

Brand: Estrace

Class: estrogen

Common Dosing by Indication:

abnormal vasomotor function, atrophic vagina (due to menopause) - 1-2mg PO daily for 21 days, then 7 days off

breast cancer (palliative) - 10mg PO TID

prostate carcinoma (palliative) - 1-2mg PO TID

decreased estrogen level - 1-2mg PO daily

osteoporosis (due to menopause) - 0.5mg PO daily for 23 days, then 5 days off

MOA: 17beta-estradiol (E2) produces proliferation of vaginal tissue, increased calcium deposition in bones

ADE (>10%): none

Monitoring Parameters:

efficacy - improvement in symptoms, improved bone density

safety - annual pap smear and breast exam, BP, TGs, TSH

Etanercept

Brand: Enbrel, Erelzi

Class: antirheumatic, TNF blocker

Common Dosing by Indication:

ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis - 50mg SUBQ once weekly OR 25mg SUBQ twice weekly

plaque psoriasis - 50mg SUBQ twice per week for 3 weeks, then 50mg SUBQ once weekly

MOA: made of TNF receptor linked to human IgG, binds to circulating TNF

ADE (>10%): diarrhea, headache, rash, antibody development, injection site reactions

Monitoring Parameters:

efficacy - improvement in symptoms

safety - screen pts for active/latent infections prior to and periodically, CBC, renal function, LFTs, C-reactive protein, skin cancer screenings, changes in mental status, HF, lupus-like symptoms

Ethinyl Estradiol and Etonogestrel Ring

Brand: NuvaRing, EluRyng, EnilloRing

Class: contraceptive

Common Dosing by Indication:

contraception - 1 ring inserted vaginally and left for 3 weeks, then removed for 1 week

MOA: none listed

ADE (>10%): headache, intermenstrual bleeding, vaginitis

Monitoring Parameters:

efficacy - lack of pregnancy, improvement in abnormal bleeding/dysmenorrhea

safety - annual pap smear and breast exam, vision changes, BP, thromboembolic disorders, depression, glycemic control, lipid profile

Etodolac

Brand: a

Class: a

Common Dosing by Indication:

a

MOA: a

ADE (>10%): a

Monitoring Parameters:

efficacy - a

safety - a

Exenatide

Brand: Byetta, Bydureon

Class: GLP-1 receptor agonist

Common Dosing by Indication:

T2DM - IR: 5-10mcg SUBQ BID within 60 min prior to morning and evening meals OR ER: 2mg SUBQ once per week

MOA: agonist of the GLP-1 receptor, alters insulin secretion and slows gastric emptying

ADE (>10%): diarrhea, nausea, injection site reactions

Monitoring Parameters:

efficacy - improved diabetes control, FBG of 80-130mg/dL, A1C<7%

safety - hypoglycemia, severe GI upset, urination changes, SOB, rash, renal function, weight, TGs, volume, pancreatitis

Febuxostat

Brand: Uloric

Class: xanthine oxidase inhibitor

Common Dosing by Indication:

hyperuricemia (in pts who cannot tolerate allopurinol) - 40mg PO daily up to 120mg/day

MOA: inhibits xanthine oxidase, preventing conversion of xanthine to uric acid

ADE (>10%): none

Monitoring Parameters:

efficacy - reduction in uric acid, less gout attacks

safety - baseline and periodic LFTs, cardiovascular events, hypersensitivity, skin reactions

Fluoxetine

Brand: Prozac, Sarafem

Class: SSRI

Common Dosing by Indication:

depression, bipolar depression - 20mg PO daily up to 80mg/day

OCD - 10-20mg PO daily up to 80mg/day

panic disorder - 5-10mg PO daily up to 60mg/day

premenstrual dysphoric disorder - 10mg PO daily up to 20-30mg/day

bulimia - 20mg PO daily up to 60mg/day

MOA: selectively inhibits presynaptic reuptake of serotonin

ADE (>10%): a

Monitoring Parameters:

efficacy - a

safety - a

Gabapentin

Brand: Neurontin, Gralise

Class: anticonvulsant, GABA analog

Common Dosing by Indication:

postherpetic neuralgia - 300mg PO on day 1, 300mg PO BID on day 2, 300mg PO TID on day 3, up to 1800-3600mg/day in 3 doses

partial seizures (add on therapy) - IR:300mg PO TID up to 1800mg/day in 3 doses

MOA: structurally similar to GABA, unknown mechanism

ADE (>10%): ataxia, dizziness, somnolence, fatigue

Monitoring Parameters:

efficacy - reduction in seizure frequency, relief of pain

safety - worsening depression, suicidality, changes in mood/behavior, renal function, LFTs, drowsiness

Glimepiride

Brand: Amaryl

Class: antidiabetic, second generation sulfonylurea

Common Dosing by Indication:

T2DM - 1-2mg PO daily up to 8mg/day

MOA: increased insulin secretion from beta cells, increased insulin action on tissues, increased glucose utilization, suppression of gluconeogenesis, increased sensitivity/numbers of insulin receptors

ADE (>10%): none

Monitoring Parameters:

efficacy - FBG of 80-130mg/dL, A1C<7%

safety - hypoglycemia, jaundice, bruising, bleeding

Glipizide

Brand: Glucotrol

Class: antidiabetic, second generation sulfonylurea

Common Dosing by Indication:

T2DM - IR: 2.5-5mg PO daily up to 40mg/day OR ER: 2.5-5mg PO daily up to 20mg/day

MOA: increased insulin secretion from beta cells, increased insulin action on tissues, increased glucose utilization, suppression of gluconeogenesis, increased sensitivity/numbers of insulin receptors

ADE (>10%): asthenia

Monitoring Parameters:

efficacy - FBG of 80-130mg/dL, A1C<7%

safety - hypoglycemia, jaundice, bruising, bleeding

Hydrocodone

Brand: Norco, Lorcet, Vicodin, Hysingla ER

Class: opioid analgesic

Common Dosing by Indication:

pain (severe) - ER(12hr): 10mg PO Q12H OR ER(24hr): 20mg PO daily

MOA: binds to opiate receptors, altering perception of pain

ADE (>10%): constipation, GI distress, somnolence

Monitoring Parameters:

efficacy - relief of pain, improved QOL

safety - rash, drowsiness, decreased breathing, constipation, black tarry stool, jaundice

Hydroxychloroquine

Brand: Plaquenil, Sovuna

Class: aminoquinoline

Common Dosing by Indication:

lupus erythematosus - 200-400mg PO daily

malaria suppression - 400mg PO once a week

malaria treatment - 800mg PO once followed by 400mg at 6, 24, and 48 hours

rheumatoid arthritis - 400-600mg PO daily, reduce dose to 200-400mg PO daily after 4-12 weeks

MOA: unknown

ADE (>10%): none

Monitoring Parameters:

efficacy - decreased pain, improved range of motion, decreased rash, improved energy, resolution/prevention of malaria

safety - palpitations, severe rash, bruising, bleeding, visual changes, eye exams, CBC, LFTs, SCr, blood glucose, electrolytes, EKG

Ibuprofen

Brand: Motrin, Advil

Class: NSAID

Common Dosing by Indication:

fever, headache - 200-400mg PO Q4-6H prn up to 1200mg/day (3200mg/day prescribed)

osteoarthritis, rheumatoid arthritis - 1200-3200mg PO daily in 3-4 doses

MOA: nonselective inhibitor of COX-1 and COX-2, reversible alters platelet function and bleeding time

ADE (>10%): none

Monitoring Parameters:

efficacy - decreased pain, improved range of motion

safety - CBC, LFTs, SCr, fecal blood test (if chronic use), rash, black tarry stools, chest pain, jaundice, weight gain, urination changes

Indomethacin

Brand: Indocin

Class: NSAID

Common Dosing by Indication:

ankylosing spondylitis, osteoarthritis, rheumatoid arthritis - IR:25-50mg PO BID-TID up to 200mg/day OR ER: 75mg PO BID

gout exacerbation - 50mg PO TID within 24 hours of onset

bursitis (shoulder) - 25-50mg PO TID for 7-14 days

MOA: nonselective inhibitor of COX1 and COX2, reversible alters platelet function and bleeding time

ADE (>10%): headache, vomiting

Monitoring Parameters:

efficacy - decreased pain, improved range of motion, resolution of symptoms

safety - CBC, LFTs, SCr, BP, fecal blood test (if chronic use), rash, black tarry stool, chest pain, jaundice, weight gain, edema, urination changes

Insulin Products

Brand: Humulin

Class: insulin

Common Dosing by Indication:

T1DM, T2DM - varies by patient needs

MOA: promotes cellular uptake of glucose, fatty acids, and amino acids

ADE (>10%): injection site reactions, weight gain

Monitoring Parameters:

efficacy - FBG of 80-130mg/dL, A1C<7%

safety - hypoglycemia

Lacosamide

Brand: Vimpat

Class: anticonvulsant

Common Dosing by Indication:

partial-onset seizure - IR:100mg PO BID up to 200mgBID/day OR ER: 200mg PO daily up to 400mg/day

tonic-clonic seizure (add on) - IR: 50mg PO BID up to 200mgBID/day OR ER: 100mg PO daily up to 400mg/day

MOA: stabilizes hyperexcitable neuronal membranes, inhibition of neuronal firing

ADE (>10%): dizziness, drowsiness, headache, nausea

Monitoring Parameters:

efficacy - resolution/decreased incidence of seizure

safety - baseline EKG, CBC, LFTs, SCr, depression, suicidality, changes in behavior, rash

Lamotrigine

Brand: Lamictal, Subvenite

Class: phenyltriazine anticonvulsant

Common Dosing by Indication:

bipolar disorder - 25mg PO daily for 2 weeks, then 100mg PO daily for 1 week, then 200mg PO daily up to 400mg/day

partial seizure - IR:100-500mg PO in 2 doses OR ER: 200-600mg PO daily

MOA: inhibition of voltage dependent sodium channels, stabilization of neuronal membranes, reduced release of excitatory neurotransmitters

ADE (>10%): nausea

Monitoring Parameters:

efficacy - resolution/decreased incidence of seizure, decreased in manic/depressive symptoms

safety - LFTs, renal function, hypersensitivity reactions, seizure frequency, suicidality, aseptic meningitis, EKG (if CVD or at risk of CVD)

Levetiracetam

Brand: Keppra, Keppra XR, Roweepra, Spiritam

Class: anticonvulsant

Common Dosing by Indication:

myoclonic seizure - 500mg PO BID up to target dose of 3000mg/day

partial seizure (add on) - IR: 500mg PO BID up to 3000mg/day OR ER: 1000mg PO daily up to 3000mg/day

tonic-clonic seizure (add on) - 500mg PO BID up to target dose of 3000mg/day

MOA: unknown

ADE (>10%): asthenia, abnormal behavior, fatigue, headache, somnolence, vomiting, increased BP

Monitoring Parameters:

efficacy - reduction in seizures

safety - depression, suicidality, changes in behavior, CNS depression, WBC, LFTs

Levothyroxine

Brand: Synthroid, Ermeza, Levoxyl

Class: thyroid supplement, synthetic thyroxine (T4)

Common Dosing by Indication:

hypothyroidism - based on patient needs, 25-50mcg PO daily initially

MOA: activates thyroid receptors proteins inside cell nucleus to activate gene transcription

ADE (>10%): none

Monitoring Parameters:

efficacy - serum TSH, T3 level (80-180ng/dL), T4 level (5-12mcg/dL)

safety - exacerbation of cardiovascular symptoms, HR, BP, bone mineral density

Linagliptin

Brand: Tradjenta

Class: dipeptidyl peptidase IV inhibitor

Common Dosing by Indication:

T2DM - 5mg PO daily

MOA: inhibition of DPP-4, prolonged incretin levels, improved regulation of glucose metabolism

ADE (>10%): hypoglycemia (when taken with insulin/sulfonylureas)

Monitoring Parameters:

efficacy - FBG of 80-130mg/dL, A1C<7%

safety - abdominal pain, hypoglycemia, skin changes, HF

Liraglutide

Brand: Victoza, Saxenda

Class: GLP-1 receptor agonist

Common Dosing by Indication:

T2DM - 0.6mg SUBQ once daily for 1 week, then 1.2mg SUBQ once daily up to 1.8mg/day

weight management - 0.6mg SUBQ once daily for 1 week, then up to target of 3mg/day

MOA: analog of GLP-1, increases insulin secretion, decreases inappropriate glucagon secretion, slows gastric emptying, increases satiety

ADE (>10%): antibody development, nausea, diarrhea, vomiting, hypoglycemia, headache, increased HR

Monitoring Parameters:

efficacy - FBG of 80-130mg/dL, A1C<7%

safety - abdominal pain, SCr, LFTs, thyroid hormone alterations, HR, depression, pancreatitis, TGs, gallbladder disease